If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email email@example.com.
Please tell us what format you need. It will help us if you say what assistive technology you use.
This form is to be completed by a member of a public authority seeking authorisation to carry out directed surveillance. If granted granted, authorisation will last for a period of up to 3 months.